民办医学院校专科教学改革的探讨

该研究以山东万杰医学院为例,针对目前招生规模越来越大,生源质量不断下滑,大面积学生逃学、厌学、考试成绩不及格的严峻现实,提出有关教学方法、教学内容和考核方式的教学三项改革,这三项改革举措顺应了当前高校教育(特别是民办高校教育)形势的发展趋势。通过改革实践,已初见成效,进一步验证了只有坚定不移地搞好教学三项改革,才能保证和提高教学质量,从而使广大学生及其家长的利益得到充分保障;也只有大张旗鼓地继续搞好教学三项改革,学校才有生存和可持续发展的空间。     

Antibiogram and plasmid profiling of carbapenemase and extended spectrum Beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae in Abeokuta,South western,Nigeria

Background

The increased reports of ESBL dissemination from various centres in south western, Nigeria and the recent emergence of carbapenem resistant bacteria prompted the conception of this study.

Objectives

To demonstrate the relationship between high molecular weight plasmids and the expression of antibiotic multi-resistance including ESBL and carbapenemase.

Methods

We investigated 97 isolates of selected organisms consisting of 67 E. coli and 30 Klebseilla spp for the presence of plasmids expressing ESBL including carbapenem-hydrolysing enzymes. Beta-lactamase was determined using acidometric method, while ESBL and carbapenemase activity was determined using the double-disk diffusion test as well as the Modified Hodge test (MHT). Plasmid profiles of ESBL and carbapenemase positive isolates were determined according to standard protocols.

Results

An ESBL prevalence rate of 21.6% and carbapenem- resistance rate of 9.3% was recorded. Antibiotic susceptibility profile of ESBL isolates showed 100.0% resistance against Amoxicillin, Cotrimoxazole and Erythromycin. Moderate susceptibility was recorded against the Quinolone class of antibiotics; Meropenem remained the most active antibiotic against ESBL isolates with 62.5% against E. coli and 60% against K. pneumoniae. The plasmid profiles of our study isolates ranged from 11.8kbp to 35.5kbp.

Conclusion

Due to the relationship between high molecular weight plasmids and multi-drug resistance, we hereby recommend regular molecular surveillance of this form in our study setting.     

A Prospective,Randomized Comparison of Modified Pulmonary Vein Isolation Versus Conventional Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation

Modified Pulmonary Vein Isolation in AF Ablation. Introduction: Pulmonary vein isolation (PVI) is the primary ablation therapy in patients with atrial fibrillation (AF). We hypothesized that high dominant frequency (DF) sites (AF nests during sinus rhythm [SR]) adjacent to the PV ostia are associated with the atrial substrate that maintains AF, and PVI incorporating the high‐frequency AF nests may have a higher efficacy. Methods and Results: In a prospective and randomized comparison, 126 symptomatic paroxysmal AF patients that underwent PVI were enrolled. We compared the efficacy of a modified PVI (ablation line: 1.0–1.5 cm from the PV ostium with encircling the AF nests [spectral analysis with DF >70 Hz during SR, Group II]) versus the anatomy‐guided conventional PVI (Group I). In Group II, the DF value along the PV ostium was lower than 70 Hz after the PVI. The primary endpoint was the freedom from symptomatic atrial arrhythmias after a single procedure. We also followed the autonomic function by a time‐domain analysis of the heart rate variability. In both groups, AF nests were observed and electric isolation was successfully obtained in all patients. With a mean duration of 16 ± 6.1 months of follow‐up, Group II had a higher single procedure efficacy without drugs (78.7% vs 66.1%, log‐rank test: P = 0.02), and fewer repeat procedures (6.6% vs 23%; P = 0.04), as compared to Group I. Conclusion: PVI incorporating the high frequency AF nests adjacent to the PV ostia had a better single procedure efficacy. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1155–1162, November 2012)     

双切口套法预防开放性胃肠手术后切口感染的临床效果观察

目的：探讨双切口套法预防开放性胃肠手术后切口感染的临床效果。方法选取2013年3月~2014年8月在本院实施开放性胃肠手术的75例患者作为研究对象,随机分为观察组(38例)和对照组(37例)。观察组在开放性胃肠手术中采用双切口套法,对照组术中不使用任何切口保护套。比较两组的手术时间、术后首次排气时间、首次排便时间、住院时间及切口感染率。结果两组的手术时间比较,差异无统计学意义(P>0.05)。观察组的术后首次排气时间、首次排便时间及住院时间显著短于对照组,差异有统计学意义(P<0.05)。观察组的切口感染率为2.63%,显著低于对照组的16.22%,差异有统计学意义(P<0.05)。结论双切口套法可以明显降低开放性胃肠手术后的切口感染率,提高临床疗效。     

Monoclonal antibodies recognizing epitopes on the extracellular face and intracellular N-terminus of the human erythrocyte anion transporter (band 3) and their application to the analysis of South East Asian ovalocytes

This report describes the production and characterization of 13 rodent monoclonal antibodies to the human erythrocyte anion transport protein AE1 (syn. band 3). Eleven antibodies (4 murine and 7 rat) recognize epitopes dependent on the integrity of the third extracellular loop of the protein. Two antibodies (1 murine and 1 rat) recognize epitopes on the N-terminal cytoplasmic domain. Quantitative binding studies using radioiodinated IgG and Fab fragments of antibodies to extracellular epitopes on AE1 ranged from 77,000 to 313,000 (IgG) and from 241,000 to 772,000 (Fab) molecules bound at saturation. The results indicate that the epitopes recognized by different antibodies vary in their accessibility and suggest that there is heterogeneity in the organization of individual AE1 molecules in the red blood cell membrane. Quantitative binding studies on South East Asian ovalocytes using several antibodies to AE1 and an anti-Wrb show a marked reduction in the number of antibody molecules bound at saturation. These results are consistent with the existence of highly cooperative interactions between transmembrane domains of AE1 in normal erythrocytes and the disruption of these interactions in the variant AE1 found in South East Asian ovalocytes.     

超声引导下心包穿刺置管引流术治疗心包积液的疗效分析

 目的 探讨超声引导下心包穿刺置管引流急慢性心包积液的疗效。方法 回顾分析2009-01至2019-08医院161例行超声引导下心包穿刺置管引流术患者的临床资料,并对其病因、症状、缓解情况进行分析。结果 161例心包积液患者前三位的病因分别为肿瘤、心力衰竭、创伤或手术,经超声引导下心包穿刺置管术治疗后症状缓解率均在70%以上。结论 超声引导下心包穿刺置管引流术治疗心包积液疗效确切,可作为临床治疗心包积液特别是急性心包压塞的首选治疗方式。     

32例国产人工髋关节翻修手术的临床体会

目的：探讨国产人工髋关节翻修原因。方法：回顾总结32例人工髋关节翻修中发现的问题,分析翻修原因。结果：32例中术前诊断松动16例,脱位4例,深部感染2例,白磨通3例,断柄2例,髋周及股部疼痛4例,股骨柄穿通皮质1例。26例取出假体顺利,6部部分骨长入珍珠面而取出假体困难。25例作全髋置换翻修,4例臼怀松动或位置不良致脱位仅翻修髋臼,1例股骨柄穿通皮质更换双动头,2例因深部感染严重而作单纯假体取出、清创术。全组病例经6个月－5年随访,Harris评分术前平均43分,术后平均81分,平均增加38分。结论：目前翻修病例仍以国产人工关节为主。翻修原因主要是：人工关节质量因素和手术技术因素。造成假体过早松动或种种其它并发症,最终失败。提示国产人工关节质量需改进,需相应配套器械,手术操作技术有待提高。     

美国脂质协会他汀药物肝脏安全性评估简介

最近．美国国家脂质协会（National Lipid Association, NLA）邀请致力于非酒精性脂肪性肝病（nonalcoholic fatty liver disease, NAFLD）,脂质代谢紊乱和药物性肝损害研究方面的肝脏病学专家加盟他汀安全性工作组．旨在对他汀肝脏安全性问题进行一次全面的、严格的、学术的、最新的以及无偏见的评估。本文主要介绍NLA与肝病专家委员之间的对话。     

新疆紫草颗粒剂与汤剂对药物流产效果影响的比较性研究

目的:比较新疆紫草颗粒剂与紫草汤剂对米非司酮配伍米索前列醇药物流产效果的影响,及不良反应。方法:将648例妊娠38-45　d、要求终止妊娠的妇女,随机分成3组,各组在米非司酮配伍米索前列醇药物流产时分别加服紫草颗粒剂或安慰剂或紫草汤剂,对3组的流产效果、出血时间、月经恢复时间等及不良反应进行观察。结果:紫草颗粒剂组和汤剂组的完全流产率(97.74%、97.70%)、平均出血时间(12.0±4.1　d、12.7±3.8　d)均无显著性差异(P均>0.05),且均显著优于安慰剂组(91.90%、14.3±4.8　d)(P均<0.05)。3组药物流产后月经恢复时间均无显著性差异。但紫草汤剂服用时有明显异味。结论:　紫草颗粒剂祛除了紫草的异味,服用方便,对其提高药物流产疗效与紫草汤剂相同,有必要进一步探讨。